TOPIC: Bihar tragedy: Reasons behind
Topic in syllabus: General studies 1 :Indian Society
Why In news:
While Bihar loses hundreds of children to AES(Acute Encephalitis Syndrome) every year, there were sharp spikes in 2012 and 2014, when 395 and 372 children, respectively, lost their lives. Through the years, AES cases have been reported from several districts in Bihar: Gaya, Patna, Aurangabad, Saran, East Champaran, Sitamarhi and Vaishali.
Encephalitis refers to an inflammation in the brain due to a viral or bacterial attack. It causes fever and almost never a drop in blood sugar. In the current epidemic, as well as in previous ones in Muzaffarpur, the doctors have marked cases of and deaths by hypoglycaemia (drop in blood sugar), which is unusual.
Ongoing heat wave:
It could be the ongoing heatwave — several parts of Patna, Gaya and even Muzaffarpur have recorded temperatures in excess of 4-5°C over what’s normal for this time of the year. At least 80 people have succumbed to the heatwave. The added heat and humidity could have made young children particularly susceptible to dehydration.
Debating the litchi link:
Spike in AES cases and in fatalities can be a result of malnourished children suffering brain damage after eating litchis, particularly unripe or overripe ones.
In 2016, a detailed investigation, published in The Lancet Global Health by the National Centre for Disease Control, India, and the U.S. Centers for Disease Control and Prevention, found “confirmation” that litchis contained a chemical called methylene cyclopropyl glycine (MCPG). These are naturally occurring toxins that cause hypoglycaemia and metabolic derangement in children.
When a child is malnourished, her body, having exhausted its reserves of glucose from the digestive tract and the liver, typically turns to fatty acids in biochemical desperation to supply blood sugar to the brain. MCPG, the theory goes, blocked this mechanism. This can send the brain into hypoglycaemic shock triggering convulsions and, if unaddressed, even death.
Virus or biological agent:
Several parents of the ailing children have been categorical that their children did not eat litchis. If malnutrition and litchi consumption were the causes, then there ought to have been a fairly constant number of deaths every year. This has not been observed.
“A peak and an ebb in cases and deaths is what we see. And that’s more typical of a biological agent.”
Poor health record:
Irrespective of whether a biological agent or malnutrition is to blame, Bihar’s poor track record in ensuring that the poorest have access to adequate nutrition and distrust in the public health care system are major causes for the deaths.
- Doctors in several primary health care centres are “afraid” of doing anything beyond the bare minimum to rescue a child. “Because the primary health care centres and health centres are located in a village or community, there’s a greater chance of violence in case a child dies. Over the years, this has led to a lack of trust among people in their nearest health facility and they opt for tertiary care.
- Bihar’s position at the bottom of national health indices makes novel diseases harder to detect and known diseases harder to treat.
According to the National Family Health Survey (NFHS) of 2015-2016, 48% of children in Bihar were stunted, compared to the national average of 38%.
Bihar also performed poorly in terms of its ability to spend and implement schemes that provided nutritious food to children and expectant mothers.
Two-thirds of eligible children did not get healthy meals, the NHFS report noted.
In 2016, a government-constituted committee prescribed guidelines:
- Children shouldn’t be allowed to skip their evening meal, they should avoid stepping out in the heat.
- Local public healthcare centres must stock up on anti-convulsion drugs as well as dextrose.
These were adhered to in 2017 and 2018. And that’s why there were relatively fewer reports of AES.
Treating it as a disaster:
The NDMA (National Disaster Management Authority) which was set up in 1999 has its brief to co-ordinate the response to “man-made and natural disasters”. Muzaffarpur is facing a disaster which is partly natural and certainly aggravated by being man-made. But it does not qualify. “Disaster”. Floods and earthquakes elicit immediate response, but not long epidemics or drought. Muzaffarpur is a national tragedy, as much as the Gujarat earthquake was, or the Kerala floods and it should be treated as one.
The debate on the underlying reason for so many deaths is an ongoing one. With a spike in deaths every year it is clear that the State has failed Muzaffarpur’s children.
It is time a scientific study is carried out and steps be taken accordingly.
Bihar loses hundreds of children to AES (Acute Encephalitis Syndrome) every year. Discuss the possible reasons behind. Also comment on the challenges involved in tackling the issue.